The Proposal of Objective Evaluation method of Treatment Level for Patients with Colorectal Perforation

Kazunari Mado, Hideki Masuda, Takero Mazaki, Yukimoto Ishii, Nobuhiko Aoki*, Hirohisa Ogame, Jun Manmoto, Nao Yoshida and Tadatoshi Takayama

Department of Digestive Surgery and Department of Breast and Endocrine Surgery*, Nihon University School of Medicine

Introduction: Treatment of patients with colorectal perforation is implemented most effectively when parameters indicating a preoperative severity score can lead to the choice of an appropriate medical institution. Methods: Comparing SOFA (SS), APACHE-II (AS), and POSSUM physiological score (PS), we propose objective preoperative severity evaluation of institutions based on a predicted value the ROC curve. Materials: Subjective were 47 cases, 24 men and 23 women averaging 65.9 years of age-old operated on at our hospital for non-iatrogenic colorectal perforation. Of the 47, 7 died during in hospitalization and 5 within 30 days of surgery, resulting in 85.1% survival. Results: Scores differed significantly with mortality (P<0.001). In ROC analysis, ROC area under the curve of AS and PS was 0.95. AS and PS were evaluated equally and excellently. ROC area under the curve of SS was 0.90. For 50% survival, the predicted value for AS was 21 and for PS was 43 by logit regression analysis. Cases exceeding these values had a poor prognosis. Discussion: AS and PS were appropriate in indicating preoperative severity. Predicted values calculated from AS and PS Logic regression analysis for mortality were appropriate in objectively evaluating institution treatment levels. Setting a cut off is therefore in deciding whether to start treatment of transfer the patient to a more appropriate institution, to ensure better survival.

Key words
colorectal perforation, severity evaluation, ROC curve, logic regression analysis, predicted value

Reprint requests
Kazunari Mado Nihon University Nerima Hikarigaoka Hospital
2-11-1 Hikarigaoka, Nerima-ku, 179-0072 JAPAN

Accepted
January 28, 2009

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